Treatment of primary internal tibial torsion is not required in most cases. Occasionally, if a child trips on his or her feet and falls frequently, or if parents are unduly concerned over toeing-in, then passive stretching exercises (externally rotating the foot at the ankle), corrective shoes (Thomas heel, longitudinal arch pad, inner-heel, and outsole wedges), or application of torque heels may be prescribed. Denis Browne splints should not be used without orthopedic consultation because they may create abnormal stress on the hip joint. Derotation osteotomy of the tibia rarely is required and then almost always when tibial torsion is associated with other orthopedic anomalies of the lower extremity. The primary care physician can usually observe children with tibial torsion. A referral is important if the child has extreme rotation, significant asymmetry of the torsion, a sudden proximal tibial deviation, or a condition that does not follow the typical pattern of improvement with growth.